Provider Demographics
NPI:1568707198
Name:POLLACK, JENNIFER (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:POLLACK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 N OXFORD AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1327
Mailing Address - Country:US
Mailing Address - Phone:773-459-2007
Mailing Address - Fax:
Practice Address - Street 1:6708 N OXFORD AVE
Practice Address - Street 2:STE 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1327
Practice Address - Country:US
Practice Address - Phone:773-459-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-08
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009977225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL056009977OtherLICENSE